April 6, 2010 -- People who have low back pain may be at increased risk for persistent or disabling symptoms if fear
of further injury causes them to avoid physical activity, a new study
says.

Low back pain accounts for 2% of office
visits in the U.S. Most patients who develop low back pain will have
substantial improvement in their pain and function within one month. However,
some patients will go on to have chronic low back pain that can persist for
several months to years.

Researchers say that people with low back pain are at increased risk for
chronic problems if they are in poor general health or have psychiatric
illnesses. Additional predictors of future chronic pain include impairment in
performing activities of daily living and difficulty coping with pain.

Poor pain coping behaviors include avoidance of work, movement, or other
activities out of fear the activities will damage or worsen the back. The
researchers also say that some patients tend to have “excessively negative
thoughts and statements about the future,” which allows them to rationalize
reasons to avoid physical activity or ignore the recommendations of their
doctors.

Identification of such tendencies could help guide doctors' decisions
regarding follow-up treatment and management of patients with low back pain,
the study says.

Patients who were willing to undergo therapy without fear of reinjury were
more likely to be pain free a year later, the researchers say.

SOURCES: Chou, R. Journal of the American Medical Association, April 7, 2010;
vol 303: no 13.